Citation Nr: 9919438
Decision Date: 07/15/99 Archive Date: 07/21/99
DOCKET NO. 94-26 825 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in Chicago,
Illinois
THE ISSUES
1. Entitlement to service connection for
hypercholesterolemia.
2. Entitlement to an increased (compensable) evaluation for
a scar on the chin.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of
the United States
INTRODUCTION
The veteran had active service from March 1982 until May 1993
and he apparently had a period of inactive duty for training
from July 1980 to February 1981.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a February 1994 decision by the
Department of Veterans Affairs (VA) Regional Office (RO) in
Chicago, Illinois.
With respect to the issues currently before the Board, the
appeal was previously remanded in February 1997.
FINDINGS OF FACT
1. The claim of entitlement to service connection for
hypercholesterolemia is not plausible.
2. The scar on the veteran's chin is no more than slightly
disfiguring and is not superficial, poorly nourished, have
repeated ulceration, or tender and painful on objective
demonstration and does not limit the function of any part
affected.
CONCLUSIONS OF LAW
1. The claim of entitlement to service connection for
hypercholesterolemia is not well grounded. 38 U.S.C.A.
§ 5107(a) (West 1991).
2. The criteria for a compensable evaluation for a scar on
the chin have not been met. 38 U.S.C.A. §§ 1155, 5107 (West
1991); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, Part 4, Diagnostic
Codes 7800, 7803, 7804, 7805 (1998).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
I. Hypercholesterolemia
The threshold question is whether the veteran's claim of
entitlement to service connection for hypercholesterolemia is
well grounded under 38 U.S.C.A. § 5107(a). A well-grounded
claim is a plausible claim that is meritorious on its own or
capable of substantiation. Murphy v. Derwinski, 1 Vet. App.
78, 81 (1990). There must be more than a mere allegation;
the claim must be accompanied by evidence that justifies a
belief by a fair and impartial individual that the claim is
plausible. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992).
Moreover, where a determinative issue involves a medical
diagnosis or medical causation, competent medical evidence to
the effect that the claim is plausible is required.
Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Espiritu v.
Derwinski, 2 Vet. App. 492, 494-5 (1992). In order for a
claim for service connection to be well grounded, there must
be evidence both of a current disability and of an
etiological relationship between that disability and service.
Caluza v. Brown, 7 Vet. App. 498, 506 (1995); Brammer v.
Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v.
Derwinski, 2 Vet. App. 141, 143 (1992).
Service connection may be established for a disability
resulting from personal injury suffered or disease contracted
in line of duty, or for aggravation of a preexisting injury
suffered or disease contracted in line of duty. 38 U.S.C.A.
§§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1998).
The Board's February 1997 remand noted that
hypercholesterolemia was defined as an excess of cholesterol
within the blood. Dorland's Illustrated Medical Dictionary,
629 (26th ed. 1974). Service medical records reflect that
the veteran's cholesterol was 253 in May 1991, 219 in January
1992, and 305 in April 1993. The report of a July 1993 VA
examination reflects diagnoses including
hypercholesterolemia.
The Board's February 1997 remand, inter alia, requested an
examination, to include an opinion as to whether it is at
least as likely as not that the veteran has current
disability manifested by hypercholesterolemia.
The report of a May 1998 VA heart examination notes that the
veteran had cholesterol of 204 in February 1998. The
diagnoses include hypercholesterolemia and no evidence of
cardiac pathology. The examiner indicated that the veteran
had a risk factor for coronary artery disease, but no
evidence of any current cardiac condition.
In order for the veteran's claim of entitlement to service
connection for hypercholesterolemia to be well grounded, he
must submit medical evidence that he currently has disability
manifested by hypercholesterolemia. There is no competent
medical evidence of record indicating that the veteran
currently has disability manifested by hypercholesterolemia.
The veteran's statements are presumed credible for purposes
of this appeal, but he is not qualified, as a lay person, to
establish a medical diagnosis merely by his own assertion, as
such matters require medical expertise. See Grottveit and
Espiritu. The competent medical evidence of record reflects
that, in response to the specific question as to whether or
not the veteran has current disability manifested by
hypercholesterolemia, he does not have cardiac pathology, but
rather has risk factor for coronary artery disease.
Therefore, the competent medical evidence reflects that the
veteran does not currently have disability manifested by
hypercholesterolemia, but rather this is a risk factor for
disability. The Board therefore concludes that without the
requisite competent medical evidence indicating that the
veteran currently has disability manifested by
hypercholesterolemia, his claim of entitlement to service
connection for hypercholesterolemia is not well grounded.
Caluza.
The Board views its discussion as sufficient to inform the
veteran of the elements necessary to complete his application
for a claim for disability compensation for the above
discussed disability. Robinette v. Brown, 8 Vet. App. 69
(1995).
II. Skin Scar
As a preliminary matter, the Board finds that the veteran's
claim for an increased rating for a scar on the skin is
plausible and capable of substantiation and, thus, well
grounded within the meaning of 38 U.S.C.A. § 5107(a). When a
veteran submits a well-grounded claim, VA must assist him in
developing facts pertinent to that claim. The veteran has
been afforded VA examinations and color photographs have been
associated with the record on appeal. The Board is satisfied
that all available relevant evidence has been obtained
regarding the claim, and that no further assistance to the
veteran is required to comply with 38 U.S.C.A. § 5107(a).
In accordance with 38 C.F.R. §§ 4.1, 4.2, and Schafrath v.
Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the
service medical records and all other evidence of record
pertaining to the history of the veteran's service-connected
disability. The Board has found nothing in the historical
record that would lead to the conclusion that the current
evidence of record is not adequate for rating purposes. The
Board is of the opinion that this case presents no
evidentiary considerations, except as noted below, that would
warrant an exposition of the remote clinical history and
findings pertaining to the disability at issue.
Disability evaluations are determined by applying the
criteria set forth in the VA's Schedule for Rating
Disabilities (Rating Schedule), found in 38 C.F.R. Part 4.
The Board attempts to determine the extent to which the
veteran's service-connected disability adversely affects his
ability to function under the ordinary conditions of daily
life, and the assigned rating is based, as far as
practicable, upon the average impairment of earning capacity
in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1,
4.10. Where there is a question as to which of two
evaluations is to be applied, the higher evaluation will be
assigned if the disability picture more nearly approximates
the criteria required for that rating. Otherwise, the lower
rating will be assigned. 38 C.F.R. § 4.7.
The report of a July 1993 VA scar examination reflects that
there was a 1-inch transverse scar at the chin. There was no
evidence of keloid formation or herniation. There was no
inflammation or swelling or depression of the scar. There
was no tenderness, no disfigurement, and no limitation of
function noted because of the scar. The diagnosis was scar
of the chin which is well healed. The report of a separate
July 1993 VA general medical examination reflects that the
veteran's face was normal.
The report of an October 1998 VA examination for scar
reflects that the veteran reported that the scar on his chin
did not cause him any pain or discomfort, but once in a while
he would nick it while he was shaving. Examination revealed
a very faint scar under the skin measuring approximately
4 centimeters in length, transversely. It was difficult to
measure because it was blended in nicely with the surrounding
skin. There was no tenderness or adhesions of the scar
tissue. Color photographs were taken and have been
associated with the record on appeal. The diagnoses included
scar under the chin.
The veteran's scar of the chin has been evaluated under the
provisions of Diagnostic Code 7800. Diagnostic Code 7800
provides that for slight disfiguring scars of the face a
noncompensable evaluation is warranted. For moderate
disfiguring scars of the face a 10 percent evaluation is
warranted. Diagnostic Code 7803 provides that scars that are
superficial, poorly nourished, with repeated ulceration,
warrant a 10 percent evaluation. Diagnostic Code 7804
provides that scars that are superficial, tender and painful
on objective demonstration, warrant a 10 percent evaluation.
Diagnostic Code 7805 provides that other scars will be rated
on limitation of function of part affected.
With respect to any degree of disfigurement the scar on the
veteran's chin causes, the Board observes that the competent
medical evidence has described the scar as well healed with
no disfigurement and that the veteran's face is normal. The
competent medical evidence has also described the scar as
being very faint and having blended in so nicely with the
surrounding skin that it is difficult to measure. The Board
observes the color photographs taken at different angles. At
either angle, the scar's appearance is very faint and it is
somewhat difficult to distinguish from the surrounding skin.
There is no competent medical evidence that describes the
scar as being disfiguring. On the basis of the competent
medical evidence which reflects that the scar is not
disfiguring as well as review of the color photographs, a
preponderance of the evidence is against a finding that the
scar is more than slightly disfiguring. Therefore, a
preponderance of the evidence is against a compensable
evaluation under Diagnostic Code 7800. Further, there is no
evidence that the scar is superficial, poorly nourished, has
repeated ulceration, or is tender and painful on objective
demonstration. Rather, the competent medical evidence
reflects that there is no tenderness and that the scar is
well healed. Further, the competent medical evidence
reflects that the scar does not affect the limitation of
function of any part. The veteran has reported that he nicks
the scar occasionally while shaving, but there is no
competent medical evidence that the symptoms associated with
the scar approximate any of the criteria required for a
compensable evaluation. Therefore, a preponderance of the
evidence is against a compensable evaluation for the scar of
the chin under any applicable rating criteria.
ORDER
Evidence of a well-grounded claim not having been submitted,
service connection for hypercholesterolemia is denied.
An increased rating for a scar on the chin is denied.
MILO H. HAWLEY
Acting Member, Board of Veterans' Appeals